NPI | 1912068537 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 003558) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 003558) |
Enumeration Date | 2006-12-13 |
Last Update Date | 2007-12-20 |